Overview

Implantable Cardioverter Defibrillators (ICDs)

ICDs have been very useful in preventing sudden death in patients with known, sustained ventricular tachycardia or fibrillation. Studies have shown that they may have a role in preventing cardiac arrest in high-risk patients who haven't had, but are at risk for, life-threatening ventricular arrhythmias.


How does an ICD work?

An ICD is usually about the size of a pager. It is made up of two parts:

A pulse generator, which includes the battery and several electronic circuits.
Wires, called leads. Depending on the type of ICD, you may have one or two    leads.

The ICD is implanted beneath the skin, near the collarbone or somewhere at or above the waistline. The leads are placed inside the heart or on its surface and are attached to the ICD.


ICD implant surgery has become a very common procedure. It is done while you are asleep, but it is not open heart surgery. After the device is implanted, doctors will perform electrophysiology studies (EPS) to make sure that the device is working properly. The procedure usually takes about two hours. You will need to stay in the hospital for at least one night after the device is implanted. Antiarrhythmic medicines may also be prescribed.
Some of the newer, smaller devices have simpler lead systems, which can be inserted with a catheterization procedure.


Once the ICD is implanted, the leads monitor your heart rate. If the ICD detects ventricular tachycardia or fibrillation, it sends out a controlled burst of impulses (called "overdrive" pacing). If that does not work, the ICD "shocks" the heart to restore a normal rhythm. Newer ICD devices can also work like a pacemaker if a slow heart rate (bradycardia) occurs. When ventricular tachycardia or fibrillation occurs, the ICD records your heart rate, as well as the date and time of the event. It can also record what electrical therapy was needed to restore a normal heart rhythm.


When are pacemakers used ?


Pacemakers may be prescribed for a number of conditions, including : -





Diagnosis for Defibrillators Implant :

Electrocardiogram (ECG): It shows how fast the heart is beating and the heart rhythm. It also records the strength and timing of electrical signals as they pass through each part of the heart.

A Holter monitor, also called an ambulatory EKG, records the electrical signals of your heart for a full 24- or 48-hour period. You wear small patches called electrodes on your chest that are connected by wires to a small, portable recorder. The recorder can be clipped to a belt, kept in a pocket, or hung around your neck. During the 24 or 48 hours, you do your usual daily activities and keep a notebook, writing down any symptoms you have and the time they occur. You then return both the recorder and the notebook to your doctor to read the results.

The purpose of a Holter monitor is to record heart signals during typical daily activities and while sleeping, and to find heart problems that may occur for only a few minutes out of the day. Also, the Holter monitor can pick up irregular heartbeats that don't cause symptoms, but are important to treat.

Echocardiogram: It provides information about size and shape of the heart and well your chambers and valves are working

Electrophysiology study: In this the doctor threads a small flexible tube from a blood vessel in your arm or leg upto your heart. Through the catheter your doctor gives you certain medicines and electrically stimulates your heart to see how your hearts electrical system responds. The electrical stimulation helps to find where the heart’s electrical system is damaged.


How often do I need to get my ICD checked?

After you get your ICD, you will have to go to the doctor for regular check-ups. ICDs can also be checked over the telephone. This is called transtelephonic monitoring. Even with telephone monitoring, you will still need to go to your doctor's office for regular check-ups. The ICD is checked with a device called a programmer. When the programmer is held over the ICD, your doctor is able to tell if the ICD is working properly, how much power is left in the battery, and if the device has delivered therapy. The programmer can also be used to change the settings of the ICD.

An ICD battery usually lasts between 4 and 8 years, depending on how many shocks it sends. When the battery runs down, a new ICD will be implanted. In most cases, your original ICD leads will not need to be replaced.


Will electronic devices affect my ICD?

If you have an ICD, you should always be aware of your surroundings. It is safe for you to be around wood working tools and normal home appliances, including microwave ovens. Stay away from heavy equipment that has very strong magnetic fields or strong electric fields (antennas, arc welders, and industrial equipment). Your doctor will help you understand what to avoid when you have an ICD.


Can I still drive a car if I have an ICD?

Many doctors will tell you not to drive for 6 months after your implantation surgery or after a shock. Talk to your doctor if you are not sure if it is safe for you to drive.


Can I use my cell phone if I have an ICD?

You should keep your cell phone at least 6 inches away from your ICD. When you are talking on your cell phone, hold it on the opposite side of the body from your ICD. Do not carry your cell phone in your breast pocket or on your belt if that means that it will be within 6 inches of your ICD.


How is an ICD implanted?

A battery-powered pulse generator is implanted in a pouch under the skin of the chest or abdomen, often just below the collarbone. The generator may be a little larger than a man’s wallet. Wires or leads run from the pulse generator to positions on the surface of or inside the heart. Newer devices are smaller and have simpler lead systems. They can be installed through blood vessels, eliminating the need for open-chest surgery.

When the ICD detects ventricular tachycardia or fibrillation, it shocks the heart to restore the normal rhythm. New devices also provide “overdrive” pacing to electrically convert a sustained ventricular tachycardia (fast heart rhythm) and "backup" pacing if bradycardia (slow heart rhythm) occurs. They also offer a host of other sophisticated functions such as storage of detected arrhythmic events and the ability to perform electrophysiologic testing.

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